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Global: over 14 million cases, 10,000 deaths
Americas: over 12 million cases, 7’000 deaths (largest outbreak in history!)
- Most in Brazil (9.8 million), followed by Argentina, Mexico, Colombia and Paraguay
- High incidences also on Caribbean islands (e.g. Guadeloupe, epidemic declared on 14 Nov 2024)
Africa: over 100,000 dengue cases
- Burkina Faso, Cameroon, Cabo Verde, CAR, Chad, Côte d'Ivoire, Ethiopia, Ghana, Guinea, Kenya, Mali, Mauritius, Niger, Nigeria, Sao Tome and Principe, Senegal, Sudan...
- CAVE: underreporting!
Asia:
- Currently outbreaks are reported especially in Bangladesh, Nepal, India, Pakistan, Southeast Asia (all countries)
Prevention: Optimal mosquito bite protection 24/7, also in cities (also against other mosquito-borne diseases such as malaria, Zika, chikungunya).
In case of fever, ensure adequate hydrations and apply paracetamol products. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
In case of fever, malaria should be always ruled out by blood tests.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
Within three weeks, mpox cases have increased by +4’758 to cumulative 14’078 confirmed cases (all clades), including 55 deaths. The following countries have reported new cases of clade I between 03 to 24 Nov 2024:
- Democratic Republic of the Congo: +3’503 cases | cumulative 10’846 cases = clade Ia and I b
- Burundi: +357 cases | cumulative 2’083 cases of clade Ib
- Uganda: +290 cases | cumulative 649 cases of clade Ib
- Central African Republic: +15 cases | cumulative 79 cases of clade Ia
- Rwanda: +11 cases | cumulative 37 cases of clade Ib
- Kenya: +5 cases | cumulative 19 cases of clade Ib
No new clade I cases have been reported within 3 weeks from Congo (22 clade Ia cases), Zimbabwe (2 clade Ib cases), and Zambia (1 clade Ib case).
A significant number of suspected mpox cases, that are clinically compatible with mpox remain untested due to limited diagnostic capacity in some African countries and thus never get confirmed.
For updates, details, suspected cases, epidemic curves, see WHO LINK).
Follow local media and local health authority advice. Prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet Mpox).
General precautions
- Worldwide:
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- Wash your hands often with soap + water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- Avoid touching potentially contaminated personal items such as bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
- Avoid sex with sick persons; use of condoms for up to 12 weeks if you sexual partner have had mpox.
- Follow advice of local authorities.
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- When travelling to endemic / epidemic areas in Africa, in addition to above mentioned general precautions:
- Avoid contact with animals in areas where mpox regularly occurs.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid contact with animals in areas where mpox regularly occurs.
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, as of 3 October 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi in case of:
- Clinical, research or laboratory work
- Working with animals
(a broader indication is still under discussion)
2. People staying outside of Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi (worldwide) in case of:
- Increased risk (e.g. laboratory workers handling mpox virus, men who have sex with men, trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
- Wash your hands often with soap / water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- You should not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries in the previous 21 days.
Further information on evaluation and diagnosis: see CDC LINK.
Since mid of November 2024, six foreign tourists died and at least four other people got ill after drinking tainted alcohol in Vang Vieng, Vientiane Province. News reports and testimonies suggest the tourists may have consumed alcohol laced with methanol.
Methanol poisoning and deaths due to adulterated alcoholic beverages are frequently reported in many countries all over the world.
Worldwide, there were an estimated 10.3 million cases of measles in 2023, a 20% increase from 2022, according to new estimates from the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). Inadequate immunization coverage globally is driving the surge in cases.
As a result of global gaps in vaccination coverage, 57 countries experienced large or disruptive measles outbreaks in 2023, affecting all regions except the Americas, and representing a nearly 60% increase from 36 countries in the previous year. The WHO African, Eastern Mediterranean, European, Southeast Asia and Western Pacific regions experienced a substantial upsurge in cases. Nearly half of all large or disruptive outbreaks occurred in the African region.
This is a reminder: Travel medicine consultation is a good opportunity to check measles vaccination status.
Swiss recommendations: all persons born after 1963 who have no documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine. In the event of an epidemic in the region or contact with a measles case, vaccination is recommended from the age of 6 months.
In 2024 and as of 15 November 2024, Dengue cases were reported in the following countries:
Burkina Faso: a total of 89’728 dengue cases (91 deaths) have been reported in all 13 regions. Most cases (51%) have been reported from the Center region. DENV-1 and DENV-3 viruses have been identified.
Cabo Verde: a total of 35’230 dengue cases (14’137 confirmed; 21’093 suspected cases ) have been reported from all nine islands. Santiago Island accounted for 82% of all confirmed cases. Serotypes DENV-1 and DENV-3 were detected.
Senegal: a total of 181 confirmed dengue cases have been identified in nine regions in Senegal, with Pikine district in Dakar region having the most cases (16), 20% of all cases. Other regions reporting a high number of cases include Thies 16 (20.0%), Louga 7 (9.0%), Fatick 6 (7.0%), Kaffrine 6 (7.0%), and Saint-Louis 4 (5.0%).
Sudan: Dengue is currently emerging as a public health problem in most states of Sudan with more than 6’000 cases reported.
Prevention: Optimal mosquito bite protection 24/7, also in cities (also against other mosquito-borne diseases such as malaria, Zika, chikungunya).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
In case of fever, malaria should be always ruled out by blood tests.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
After a trip to Zimbabwe, African trypanosomiasis was diagnosed in a traveler in Vienna. The patient is hospitalized and under treatment.
African trypanosomiasis, also called sleeping sickness, is endemic in many Subsaharan countries (see map).
It is transmitted by Tsetse flies. These flies are mainly attracted by bright, dark (especially blue) colours. They inhabit rural areas, including forests and savannah areas, and areas of thick vegetation along rivers and waterholes, depending on the fly species. Tsetse flies bite during the day, <1% are infected. Risk for infection in travelers increases with the number of fly bites, which does not always correlate with duration of travel. People most likely to be exposed to African trypanosomiasis infection are hunters and villagers with infected cattle herds. Tourists and other people working in or visiting game parks are at risk for contracting African trypanosomiasis if they spend long periods in rural areas where the disease is present. Travelers to urban areas are at minimal risk, although transmission has been observed in some urban settings in the past.
For details, see WHO Factsheet.
As of 13 November 2024, a total of 494 confirmed cases of mpox and one death have been reported in Uganda. Confirmed cases have been reported in 38 districts, with the most affected districts including Kampala (61% of cases), Wakiso and Nakasongola. For details, see LINK.
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet Mpox).
General precautions
- Worldwide:
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- Wash your hands often with soap + water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- Avoid touching potentially contaminated personal items such as bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
- Avoid sex with sick persons; use of condoms for up to 12 weeks if you sexual partner have had mpox.
- Follow advice of local authorities.
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- When travelling to endemic / epidemic areas in Africa, in addition to above mentioned general precautions:
- Avoid contact with animals in areas where mpox regularly occurs.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid contact with animals in areas where mpox regularly occurs.
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, as of 3 October 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi in case of:
- Clinical, research or laboratory work
- Working with animals
(a broader indication is still under discussion)
2. People staying outside of Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi (meaning worldwide) in case of:
- Increased risk (e.g. laboratory workers handling mpox virus, men who have sex with men, trans-persons with multiple sexual partners), see Swiss recommendations: see LINK.
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
- Wash your hands often with soap /water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- You should not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries in the previous 21 days.
- Further information on evaluation and diagnosis: see CDC LINK.
In the province of Córdoba, an outbreak of trichinellosis has caused a health alarm after the Ministry of Health confirmed 41 cases in 5 localities.
Trichinella infections are frequently reported in Argentina. Homemade sausage foods do not usually go through sanitary and may be sold on the routes and roads of the country.
Trichinellosis is caused by the larvae of an intestinal worm when eating insufficiently cooked meat (mainly pork, but also game and other animals such as bear). Symptoms vary widely: muscle pain, inflammation of the eyelids and eye pain, diarrhea, and fever. Cardiac and neurological complications are possible, and the disease is sometimes fatal.
On 8 November 2024, the Centers for Disease Control and Prevention (CDC), reported a higher than expected number of US travellers returning from the state of Telangana in India with chikungunya.
According to WHO, between 1 January and 20 October 2024, over 7.3 million malaria cases and 1’157 deaths (CFR 0.02%) were reported in Ethiopia (estimated population of around 124 million). Of the total cases reported in 2024, majority (95%) were laboratory-confirmed, with Plasmodium falciparum accounting for more than two-thirds of the cases. By contrast, in 2023, 4.1 million malaria cases including 527 deaths were reported, of which Plasmodium falciparum accounted for approximately 70% of all reported cases.
Four regions accounted for 81% of the reported cases and 89% of health facility malaria deaths in 2024: Oromia (44% cases; 667 deaths), Amhara (18% cases; 56 deaths), Southwest (12% cases; 250 deaths) and South Ethiopia Regional State (7% cases; 45 deaths). Due to favorable geo-ecological conditions, the Western part of the country is experiencing a high malaria burden and is highly affected by the current unprecedented surge as shown in the incidence map for week 42.
The increasing trend in the number of annual cases and endemic areas are likely influenced by reduced vector control efforts, exacerbated by acute and protracted conflicts affecting some Regional States.
Challenges remain in delivering essential health care services, including malaria treatment, in health facilities due to access challenges and barely functioning health facilities in areas affected by conflicts. The presence of other concurrent disease outbreaks and humanitarian emergencies in the country further exacerbates these challenges. WHO assesses the national risk for malaria in Ethiopia as high due to multiple factors including the spread of Anopheles stephensi, drought and food insecurity, climate change-induced extreme weather events and ongoing conflicts.
Geographical distribution of Malaria cases as of 20 October 2024:
The death of a young man who was bitten by a pet dog has triggered a debate about the spread of rabies in Morocco.
According to data from the Ministry of Health and Social Protection, Morocco recorded 414 cases of rabies between 2000 and 2020, averaging 20 cases per year, with 180 of these cases involving children under 15.
Information about rabies and what to do if exposed is important for all travellers!
Prevention: Avoid contact with animals! Do not feed animals either! Pre-exposure vaccination is particularly recommended for travelers with increased individual risk (working with animals, travel on two-wheelers, to remote areas, young children, cave explorers, possible contact with bats, frequent travels etc.).
Behavior after exposure: After an animal bite/scratch: immediately wash the wound with water and soap for 15 minutes, then disinfect and in any case visit a medical center for post-exposure vaccination as soon as possible! For more information: see Flyer rabies.
Zika is endemic in Thailand. CDC does not classify Thailand as an area with a current outbreak (see CDC map).
Optimal mosquito bite protection 24/7, also in cities (during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria).
For detailed ECTM recommendations on Zika, see link. In case of fever, malaria should always be ruled out by blood test.
On 27 September 2024, Rwanda reported its first Marburg virus disease outbreak (MVD), see also previous EpiNews.
- The highest number of new confirmed cases were reported in the first two epidemiological weeks of the outbreak with 26 cases reported in epidemiological week 39 (23 to 29 September 2024) and 23 cases in week 40 (30 September to 6 October). This was followed by a sharp decline in weeks 41 and 42, with 12 and one case reported respectively.
- As of 29 October 2024, 65 cases of MVD have been reported, including 15 deaths (23%); 3 patients are in isolation. So far, 47 patients have recovered. For updates, see LINK.
- Most of the people infected are health workers, particularly those who work in intensive care units.
- Contact tracing is ongoing, with 1’146 contacts under follow-up as of 20 October 2024.
- Based on available updates from the outbreak investigation, the index case was a male between 20 and 30 years old with a history of exposure to bats in a cave.
Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.
Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Humans can also get infected by direct contact with an infected animal (e.g., non-human primate).
Person-to-person transmission occurs by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment. MVD is not an airborne disease, and a person is not contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.
Incubation period: usually five to ten days (range 2-21 days).
Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas.
Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.
Further information, see ECDC Factsheet Marburg Virus, CDC.
Follow media and official reports! Follow all the recommendations of the local health authorities!
Travellers should be made aware of the ongoing outbreak. The risk for travellers to Rwanda is assessed as low, but it is high for family members and caregivers who have contact with sick people.
Preventive measures:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids.
- Avoid visiting healthcare facilities in the MVD-affected areas for no urgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals, alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks and eye protection.
- Practice safer sex.
Upon return from Rwanda:
- Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).
In case of symptoms:
If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
For clinicians:
- Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
- Further information on evaluation and diagnosis: see LINK and ECDC risk assessment.
According to WHO, between 2 to 29 September 2024 (week 36 to 39), 17 countries shared their meningitis epidemiological data.
Epidemic:
- Benin: Zoe region (Abdomey health district, crossed epidemic threshold on weeks 33 and 34), remaining in epidemic phase on week 36
Alert:
- Benin: Alibori region, Atacora region, Bargou region, Collines region
- Mali: Bamako region
For previous epidemics and alerts, see EpiNews or news at www.healthytravel.ch.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended:
- During epidemics or alerts, vaccination is recommended for stays > 7 days or in the case of close contact with the population.
If no alert or epidemic is reported, vaccination is recommended for travel to the ‘meningitis belt’ during the dry season (typically occurring from December to June) across sub-Saharan Africa if
- Travelling for >30 days or
- For shorter stays, depending on the individual risk (e.g. close personal contacts, work in health care facilities, stay in heavily occupied accommodation, risk of epidemics).
Ethiopia is facing a significant malaria crisis, reporting a total of 5’723’754 cases from 1 January to 15 September 2024. Four regions of Oromia, Amhara, Southwest, and South Ethiopia Regional State comprise 80.0% of all cases. The resurgence of Malaria in Ethiopia is exacerbated by the suspension of malaria control programs, especially in conflict-affected regions, which has created vulnerable living conditions due to displacement, among others.
In Epidemiological Week 36 alone, there were 227’675 malaria cases and 18 deaths. A significant proportion of the cases (over 81.0%) came from four regions: Oromia (440%), Amhara (18.0%), Southwest (12.0%), and South Ethiopia Regional State (7.0%). Of the cases in week 36, 98.0% were confirmed through laboratory testing, and Plasmodium falciparum accounted for 62.0%
Prevention: Optimal mosquito bite protection 24/7, also in cities (also against other mosquito-borne diseases such as malaria, Zika, chikungunya).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
In case of fever, malaria should be always ruled out by blood tests.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
While further information is pending, in addition to the basic immunization against polio, a booster vaccination is recommended for:
- immunocompetent travellers <65 years: every 20 years
- immunocompetent travellers ≥65 years: every 10 years
- travellers with immunodeficiency: every 10 years
On 28 October 2024, the US Center of Disease Control and Prevention reported a suspected imported case of Lassa fever in an Iowa resident. The case recently to West Africa (country unspecified) in early October 2024 and became ill upon return and was isolated in a hospital where he died end of October.
Lassa fever is endemic in West Africa with 100’000 to 300’000 cases reported each year.
Sporadic cases have been reported among returning travellers: In the past 10 years, EU/EEA countries have reported seven Lassa fever cases to ‘The European Surveillance System’ (TESSy). Two cases were reported by the UK (ex-Nigeria and ex-Mali) in 2009, one by Sweden (ex-Liberia) in 2016, two by Germany (ex-Togo and a secondary case infected in Germany) in 2016 and two by the Netherlands (ex-Sierra Leone) in 2019. In the USA, there have been nine imported Lassa fever cases since 1969.
The NHS has sounded an alarm with a 10-day COVID warning, calling for vigilance as the number of cases climbs. According to recent figures released by the UK Health Security Agency (UKHSA), there's been a 17.8% week-on-week increase in COVID infections in England and a sharp 27.3% rise in related fatalities.
In the EU/EEA, there has been a downward trend of COVID-19 activity since the peak in July 2024, including in most of the countries that experienced a later epidemic during the summer. People aged 65 years and above continue to represent the main age group at risk of hospitalization and severe outcomes due to COVID-19.
On 27 September 2024, Rwanda reported its first Marburg virus disease outbreak (see EpiNews as of 3 Oct 2024). Updates as of 18.10.2024:
- As of 16 October 2024, 62 cases of MVD have been reported, including 15 deaths (case fatality rate: 24%); 9 patients are in isolation. So far, 38 patients have recovered. For updates, see LINK. Cases are reported from eight of the 30 districts. Health care workers continue to be disproportionately affected.
- Treatment trial: WHO announced the commencement of a randomized, controlled trial to test remdesivir and a monoclonal antibody designed specifically against MARV (derived from antibodies from a MVD survivor). Link to study with NHP model. Gilead donates remdesivir for emergency use to Rwanda.
- Vaccination: On 6 October 2024, vaccinations (provided by Sabin Vaccine Institute) for healthcare workers and high risk contacts started as part of a Phase 2 rapid response open-label study; as of 16.10.2024 a total of 856 doses have been administered. Link to phase 1 study of the cAd3-vector based vaccine (single-dose i.m.). Link to the Marburg virus vaccine consortium, MARVAC. Link to GAVI, Marburg-page.
- Rwanda continues implementing a number of control measures including: entry and exit screening at the airport, see EpiNews of 10.10.2024,
- Link to history of Marburg Outbreaks via CDC webpage, see LINK.
- CDC has put Rwanda on alert level 3 (Reconsider nonessential travel to the Republic of Rwanda).
- As of 14 October 2024, the US Department of Health and Human Services started public health entry screening for those entering the country after having been to Rwanda the past 21 days, see LINK.
Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.
Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Humans can also get infected by direct contact with an infected animal (e.g., non-human primate).
Person-to-person transmission occurs by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment. MVD is not an airborne disease, and a person is not contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.
Incubation period: usually five to ten days (range 2-21 days).
Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas.
Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.
Further information, see ECDC Factsheet Marburg Virus, CDC
WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.
ECDC assess the overall risk for EU/EEA citizens visiting or living in Rwanda as low. This is because the likelihood of exposure to MVD – considering the low number of cases reported and the mode of transmission – and the impact are both assessed as low. For details, see LINK.
Follow media and official reports! Follow all the recommendations of the local health authorities!
Travellers should be made aware of the ongoing outbreak. The risk for travellers to Rwanda is assessed as low, but it is high for family members and caregivers who have contact with sick people.
Preventive measures:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids.
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals, alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks and eye protection.
- Practice safer sex.
Upon return from Rwanda:
- Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).
In case of symptoms
If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
For clinicians:
- Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
- Further information on evaluation and diagnosis: see LINK and ECDC risk assessment.
In urban districts of Hong Kong further cases of melioidosis were confirmed. Melioidosis is endemic in Hong Kong, though case numbers are low (18 so far in 2024). This serves as a reminder that this infection – though commonly associated with out-door and rural environments – is indeed also endemic in metropolitan surroundings.
Melioidosis is an endemic disease in Asia and Northern Australia. Cases have also been reported from Africa, the Caribbean basin, and the Americas. Cases may increase after hurricanes, heavy rain, typhoons, and other severe weather events.
Melioidosis mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal and liver disease, and others. Information on melioidosis: see CDC.
On 27 September 2024, Rwanda reported its first Marburg virus disease outbreak (see EpiNews as of 3 Oct 2024).
- As of 10 October 2024, 58 cases of MVD have been reported, including 13 deaths (case fatality rate: 22%); 30 patients are in isolation. So far, 12 patients have recovered. For updates, see LINK.
- The cases are reported from eight of the 30 districts in the country. Among the confirmed cases, over 80% are health care workers from two health facilities in Kigali. Contact tracing is underway and follow-up of more than 300 contacts is ongoing.
- On 6 October 2024, vaccinations for healthcare workers and high risk contacts started as part of a Phase 2 rapid response open-label study; vaccines have been provided by Sabin Vaccine Institute.
- Rwanda has been implementing a number of control measures including: entry and exit screening at the airport, measures in education settings and conferences, ban on patient visits to hospitals, strengthening infection prevention and control protocols in hospitals, and measures to limit contact with dead bodies.
- CDC has put Rwanda on alert level 3 (Reconsider nonessential travel to the Republic of Rwanda).
- On 7 October 2024, the US Department of Health and Human Services announced that on the week of 14 October 2024 US CDC will start public health entry screening for those entering the country after having been to Rwanda the past 21 days, see LINK.
Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.
Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Humans can also get infected by direct contact with an infected animal (e.g., non-human primate).
Person-to-person transmission occurs by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment. MVD is not an airborne disease, and a person is not contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.
Incubation period: usually five to ten days (range 2-21 days).
Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas.
Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.
Further information, see ECDC Factsheet Marburg Virus, CDC.
WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.
ECDC assess the overall risk for EU/EEA citizens visiting or living in Rwanda as low. This is because the likelihood of exposure to MVD – considering the low number of cases reported and the mode of transmission – and the impact are both assessed as low. For details, see LINK.
Follow media and official reports! Follow all the recommendations of the local health authorities!
Travellers should be made aware of the ongoing outbreak. The risk for travellers to Rwanda is assessed as low, but it is high for family members and caregivers who have contact with sick people.
Preventive measures:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids.
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals, alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks and eye protection.
- Practice safer sex.
Upon return from Rwanda:
- Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).
In case of symptoms
If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
For clinicians:
- Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
- Further information on evaluation and diagnosis: see LINK and ECDC risk assessment.
Information about rabies and what to do if exposed is important for all travellers!
Prevention: Avoid contact with animals and do not feed them! Pre-exposure vaccination is particularly recommended for travellers with increased individual risk (working with animals, travel on two-wheelers, to remote areas, young children, cave explorers, possible contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: immediately wash the wound with water and soap for 15 minutes, then disinfect and in any case visit a medical center for post-exposure vaccination as soon as possible! For more information: see Flyer rabies.
On 13 September 2024, the IHR NFP for Barbados notified WHO of one confirmed human infection with West Nile Virus (WNV) in a child. This marks the first detected human case of WNV reported from Barbados.
Additionally, no infections have been previously documented in birds or horses in this country, making this case both unusual and unexpected. However, the WNV has spread throughout the Caribbean, likely via infected migratory birds. It is possible that the virus is circulating in birds and horses undetected.
West Nile viruses belong to the flavivirus family and are transmitted by Culex mosquitoes. The main hosts are birds; humans are false hosts. Most cases are asymptomatic; clinically symptomatic cases develop fever and meningitis or encephalitis. Elderly persons, pregnant women and immunosuppressed persons are at higher risk for a neuroinvasive form of the disease.
The following precautions are recommended:
- Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
- Do not touch sick or dead birds, as they may also be infected.
- If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after returning.
The number of people affected by leptospirosis and related deaths in Kerala is increasing. In the first 4 days of October 2024 alone, 45 people were diagnosed with the disease.
According to the Health Department, from 1 Jan to 4 Oct 2024, a total of 2’512 people have been diagnosed with leptospirosis, including 155 confirmed deaths. Additionally, 1’979 people sought treatment for symptoms related to the illness. Similarly, 131 deaths suspected to be caused by leptospirosis symptoms were also reported.
Health officials warn that the disease is now spreading during all seasons.
Leptospirosis: Leptospires are transmitted via the urine of rodents (especially rats), e.g. in water residues (rivulets, puddles, etc.) or mud. Transmission to humans occurs through direct or indirect contact with rodent urine via small skin lesions or mucosal surfaces. The clinical picture ranges from flu-like general symptoms to aseptic meningitis and sepsis. Vaccination is not available.
Prevention: Wear waterproof protective clothing/boots when wading through water! Cuts or scratches should be covered with waterproof bandages. Vaccination is not available for travelers.
As of 3 October, 130 locally acquired dengue cases have been reported by the Italian National Public Health Authority. These are 63 more cases than reported in the previous week's update. The newly reported cases were from Marche (51 cases), Emilia Romagna (14 cases) and Lombardy (one case). According to local authorities in the Marche Region, there is a decreasing trend in case numbers reported from Fano.
For 129 cases NUTS2 regions were reported:
- Marche (102 cases)
- Emilia Romagna (19 cases)
- Lombardy (six cases)
- Tuscany (one case)
- Veneto (one case).
An additional case (onset of symptoms 18 August, DENV 2) was reported by the Abruzzo region. However, the place of infection is currently under investigation as the infection may have occurred in another region.
Prevention: Optimal mosquito bite protection during the day, also in cities.
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
In 2024 and as of 2 October 2024, 18 countries in Europe have reported 1’202 locally acquired human cases of West Nile Virus (WNV) infection with known place of infection. The earliest and latest date of onset were respectively on 1 March 2024 and 26 September 2024.
Locally acquired cases were reported by Italy (422), Greece (202), Spain (114), Albania (102), Hungary (101), Romania (71), Serbia (53), Austria (34), Türkiye (30), France (27), Croatia (20), Germany (8), Slovenia (5), Kosovo (4), Slovakia (4), Bulgaria (2), North Macedonia (2) and Czechia (1).
In Europe, 88 deaths were reported by Greece (31), Italy (16), Albania (13), Romania (10), Spain (10), Bulgaria (2), Serbia (2), Türkiye (2), France (1) and North Macedonia (1).
Case numbers reported this year are above the mean monthly case count for the past 10 years. During the same period in 2023, 681 cases had been reported. However, numbers are lower than in 2018, when 1 728 cases had been reported by this time of year.
Distribution of locally acquired human West Nile virus infections in 2024 till 2 October 2024:
Of note, further regions of infection were reported in 2023.
The following precautions are recommended:
- Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
- Do not touch sick or dead birds, as they may also be infected.
- If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after returning.
On 2 October 2024, Germany reported that two travellers returning from Rwanda were isolated at the University Medical Center Hamburg (UKE) on suspicion of Marburg virus disease (MVD). Both tested negative on 3 October. One of the cases is a medical student who worked in a hospital in Rwanda, where he was exposed to a patient infected with MVD around 25 September, while wearing appropriate protective equipment. He will continue to be monitored for his own safety until the end of the incubation period of up to 21 days. In the coming days, he is to remain in quarantine at the UKE's special unit for highly contagious infectious diseases, followed by home quarantine under the supervision of the responsible public health department.
The companion also tested negative and is showing mild symptoms of another disease. The companion had no contact with MVD-infected persons in Rwanda. The accompanying person will also continue to be monitored at the UKE over the weekend.
See news above.
The negative test result and the absence of symptoms during the returning trip rule out any risk to third parties. Thus, there was no risk of infection with the Marburg virus for either the air or rail travellers at any time.
On 27 September 2024, the Rwanda Ministry of Health announced the confirmation of Marburg virus disease in patients in health facilities in the country. As of 3 October, 36 cases of MVD have been reported, including 11 deaths (Case fatality rate: 31%). The cases are reported from seven of the 30 districts in the country (Gasabo, Gatsibo, Kamonyi, Kicukiro, Nyagatare, Nyarugenge and Rubavu districts). Among the confirmed cases, over 70% are health care workers from two health facilities in Kigali. Contact tracing is underway with 410 contacts under follow-up. The source of the infection is still under investigation.
One contact travelled to Belgium from Rwanda. WHO was made aware of this by the public health authorities in Belgium. They shared detailed information on the contact's situation, that they remained healthy, completed the 21-day monitoring period, did not present with any symptoms, and are not a risk to public health.
This is the first time MVD has been reported in Rwanda. The Government of Rwanda is coordinating the response with support from WHO and partners. The Ministry of Health of Rwanda announced several control measures including a ban on patient visits to hospitals, strengthening protocols in hospitals, and measures to limit contact with dead bodies.
Rwanda will start cinical trials of experimental vaccines and treatments for MVD in the next few weeks.
Marburg virus disease (MVD) is a rare but severe hemorrhagic fever, caused by Marburg virus (MARV). Although MVD is uncommon, MARV has the potential to cause outbreaks with significant case fatality rates (up to 88%). All recorded MVD outbreaks have originated in Africa.
Transmission: Fruit bats are the natural reservoir of MARV. The majority of MVD outbreaks have been connected to human entry into bat-infested mines and caves. Human can also get infected by direct contact with an infected animal (e.g., non-human primate).
Person-to-person transmission occur by direct contact (through broken skin or mucous membranes) with infected blood, secretions, and body fluids or by indirect contact with contaminated surfaces and materials like clothing, bedding and medical equipment MVD is not an airborne disease, and a person is not contagious before symptoms appear. As a result, if proper infection prevention and control precautions are strictly followed, the risk of infection is regarded as minimal.
Incubation period: usually five to ten days (range 2-21 days)
Symptoms: The onset of MVD is usually abrupt, with non-specific, flu-like symptoms such as a high fever, severe headache, chills and malaise. Rapid worsening occurs within 2–5 days for more than half of patients, marked by gastrointestinal symptoms such as anorexia, abdominal discomfort, severe nausea, vomiting, and diarrhea. In severe cases, a rash may develop, along with bleeding from various body areas.
Treatment: There are several experimental drugs and vaccines for Marburg, but none has been licensed to date.
Further information, see ECDC Factsheet Marburg Virus. CDC.
WHO assesses the risk of this outbreak as very high at the national level, high at the regional level, and low at the global level.
Follow media and official reports. The risk for travellers is usually very low, but it is high for family members and caregivers who have contact with sick people.
Preventive measures:
- Wash your hands regularly and carefully using soap and water (or alcohol gel if soap is unavailable).
- Avoid contact with sick people who have symptoms, such as fever, muscle pain, and rash.
- Avoid contact with blood and other body fluids
- Avoid visiting healthcare facilities in the MVD-affected areas for nonurgent medical care or non-medical reasons.
- Avoid contact with dead bodies or items that have been in contact with dead bodies, participating in funeral or burial rituals, or attending a funeral or burial.
- Avoid handling, cooking, or eating bush/wild meat (meat of wild/feral mammals killed for food).
- Wash and peel fruit and vegetables before consumption.
- Avoid visiting mines or bat caves and contact with all wild animals; alive or dead, particularly bats.
- If you decide to visit mines or caves inhabited by fruit bat colonies, wear gloves and other appropriate protective clothing, including masks.
- Practice safer sex.
Upon return from Rwanda:
- Watch your health for symptoms of Marburg while in the outbreak area and for 21 days after leaving the outbreak area (no quarantine is required if there are no symptoms).
In case of symptoms
If you develop fever and nonspecific symptoms such as chills, headache, muscle pain or abdominal pain:
- you should separate yourself from others (isolate) immediately and
- directly contact the in-country hotline by phone or contact a tropical institute or university hospital infectious disease unit.
- alert the healthcare providers of your recent travel to an area with a Marburg outbreak.
For clinicians:
- Consider Marburg as a possible diagnosis in patients with epidemiologic risks factors, especially in people with possible exposure of Marburg cases in Rwanda.
Further information on evaluation and diagnosis: see LINK.
According to WHO, between 29 to 1 September 2024 (week 31 to 35), 19 countries shared their meningitis epidemiological data.
Epidemic:
- Benin: Zoe region (Abdomey health district, crossed epidemic threshold on weeks 33 and 34)
- D.R. Congo: Province Sud-Ubangui and province Sankuru
Alert:
- Benin: Bargou region, Collines region
- D.R. Congo: Haut – Lomami province, Ituri province, Lomami province, Maindombe province
- Ghana: Savannah region
- Mali: Bamako region
For previous epidemics and alerts, see EpiNews or news at www.healthytravel.ch.
Vaccination with a quadrivalent meningococcal conjugate vaccine (Menveo® or Nimenrix®) is recommended:
- During epidemics or alerts, vaccination is recommended for stays > 7 days or in the case of close contact with the population.
If no alert or epidemic is reported, vaccination is recommended for travel to the ‘meningitis belt’ during the dry season (typically occurring from December to June) across sub-Saharan Africa if
- Travelling for >30 days or
- For shorter stays, depending on the individual risk (e.g. close personal contacts, work in health care facilities, stay in heavily occupied accommodation, risk of epidemics).
As of 27 September 2024, a total of 294 Zika virus cases across 40 provinces have now been reported for 2024.
More than 750 Zika cases were reported in the whole of 2023. Due to an increased number of imported Zika cases in returning travellers (n=25), particularly with exposure in the second half of 2023 (n=21), ongoing transmission of Zika virus in Thailand was assumed, leading the Swiss ECTM to issue special recommendations in February 2024 (EpiNews 2 February 2024).
Zika is endemic in Thailand. The current numbers do not indicate an increasing ongoing transmission. CDC does not classify Thailand as an area with a current outbreak (see CDC map). As a result, the Swiss Expert Committee for Travel Medicine updates its ZIKA prevention recommendations for travellers to Thailand as follows:
Optimal mosquito bite protection 24/7, also in cities (during the day against dengue, chikungunya, Zika and other viruses, at dusk and at night against malaria).
For detailed ECTM recommendations on Zika, see link. In case of fever, malaria should always be ruled out by blood test.
Die Zahl der in den USA im Jahr 2024 bisher gemeldeten Pertussis- oder Keuchhustenfälle ist nach den neuesten Daten der Centers for Disease Control and Prevention (CDC) mehr als viermal so hoch wie zum gleichen Zeitpunkt des letzten Jahres. Bis zum 14. September wurden 14’569 Pertussis-Fälle gemeldet. Dies entspricht einem Anstieg von 319 %.
Auch Australien verzeichnet einen deutlichen Anstieg der Pertussisfälle. Laut den dortigen Gesundheitsbehörden und Stand vom 21. September dieses Jahres wurde insgesamt 29’648 Fälle, die höchste Zahl seit 2011, als 38’748 Fälle gemeldet wurden, registriert.
Dies ist eine Erinnerung daran, dass eine reisemedizinische Beratung eine Gelegenheit ist, den Pertussis-Impfstatus zu überprüfen. Schweizer Empfehlungen: Nach der Grundimmunisierung gegen Keuchhusten werden Auffrischungsimpfungen bei Jugendlichen (11-15 Jahre) und Erwachsenen (25-29 Jahre) empfohlen.
Eine Auffrischungsimpfung ist auch bei jeder Schwangerschaft angezeigt. Zusätzlich sollten sich Jugendliche und Erwachsene jeden Alters gegen Keuchhusten impfen lassen, wenn beruflich oder familiär regelmässiger Kontakt mit Säuglingen unter 6 Monaten besteht und die letzte Impfung gegen Keuchhusten 10 Jahre oder länger zurückliegt.
Between epidemiological week (EW) 1 and EW 35 of 2024, 38 confirmed human cases including 19 deaths of yellow fever (YF) have been reported in 5 countries of the Americas Region: Bolivia (7 cases, including 4 with history of YF vaccination), Brazil (3 cases, including 1 case with history of YF vaccination in 2017), Colombia (8 cases, including 1 cases with history of YF vaccination), Guyana (2 cases), and Peru (18 cases). For details, see LINK.
Geographical distribution of municipalities with occurrence of yellow fever cases in humans in Bolivia, Brazil, Colombia, Guyana, and Peru, years 2022, 2023, and 2024 (as of EW 35):
Mozambican health authorities have detected measles outbreaks in 4 districts of the northern province of Cabo Delgado, and warned that the outbreaks have worsened over the past 2 months.
Neighbouring Malawi has also issued an alert after detecting measles cases.
This is a reminder that all travelers should be updated with measles vaccination.
Swiss recommendations: all persons born after 1963 who have no documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine.
In the event of an epidemic in the region or contact with a measles case, vaccination is recommended from the age of 6 months.
The number for Zika cases in Pune have increased to more than 100 cases, including 5 deaths. All deaths were in elderly people with co-morbidities.
End of August 2024, the US CDC issued an alert on a Zika outbreaks in the state of Maharashtra.
There is currently an increased risk of transmission of the Zika virus in the state of Maharashtra, India. Please note that the Zika virus can also be transmitted sexually!
Prevention: Optimal mosquito protection 24/7: during the day against Zika, dengue and other arboviruses, at dusk and at night against malaria.
When travelling to areas with a Zika outbreak, as is now the case in the state of Maharashtra, India, the Swiss Expert Committee for Travel Medicine recommends using a condom/femidom during the trip and for at least 2 months after returning home to prevent possible sexual transmission of the virus.
Due to the risk of malformations in the unborn child, pregnant women are currently advised not to travel to the state of Maharashtra in India. If travelling is absolutely necessary, it is recommended that you speak to a specialist in travel medicine before departure.
Women planning to become pregnant should wait at least 2 months after their return (or that of their partner) from India before starting family planning. In the case of medically assisted reproduction, this period should be extended to at least 3 months. Please also read the Zika information sheet, especially if you are pregnant or if you or your partner are planning a pregnancy.
In 2024 and as of 4 September 2024, 15 countries in Europe have reported 715 locally acquired human cases of WNV infection. The earliest and latest date of onset were respectively on 1 March 2024 and 29 August 2024. Locally acquired cases were reported by Italy (287), Greece (138), Albania (74), Spain (54), Hungary (43), Romania (42), Serbia (27), Austria (18), France (15),
Türkiye (7), Croatia (3), Bulgaria (2), Germany (2), Kosovo (2) and North Macedonia (1).
In Europe, 51 deaths were reported by Greece (17), Albania (13), Italy (10), Spain (4), Romania (3), Bulgaria (2), France (1) and Serbia (1).
In addition, Slovenia reported three human cases of WNV infection through EpiPulse in the Pomurska and Podravska regions. These cases had not been reported through TESSy by 4 September and are therefore not included in this monthly WNV report.
Case numbers reported this year are above the mean monthly case count of the past 10 years. For instance, during the same period in 2023, 445 cases had been reported. Numbers are, however, lower than in 2018, when 1 048 cases had been reported by this time of year.
Distribution of locally acquired human West Nile virus infections in 2024 till 11 September 2024:
The following precautions are recommended:
- Protect yourself against mosquito bites during the day and at night (see factsheet mosquito and tick bite protection).
- Do not touch sick or dead birds, as they may also be infected.
- If you have visited a West Nile fever transmission area, do not donate blood for at least 28 days after returning.
- Ensure good hand hygiene: wash your hands with soap and water or a disinfectant alcohol gel before cooking or eating and after using the toilet.
- Consume only well-cooked/fried foods that are served hot. Avoid salads, unpeeled fruits, foods with raw eggs, soft ice cream and similar products.
- Drink water only from bottles that have been properly sealed. Ice cubes should be avoided.
Avoid bathing, washing, or walking in fresh water.
Consult a general practitioner or a specialist in travel and tropical medicine after suspected skin contact with fresh water during your trip.
The Los Angeles County Public Health Department has confirmed a case of locally acquired dengue from a resident who has no history of travel to areas where dengue fever is endemic. According to a release from the health department, the infected person resides in Baldwin Park.
It is the third case of locally acquired dengue in California and the first reported by the Los Angeles County Department of Public Health. Cases of locally acquired dengue were previously confirmed by Long Beach and Pasadena in fall 2023.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
The number of cases in 2024 period already cross those of the entire 2023 (n= 19’300).
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
In two weeks (19 – 21 Sep 2024) the "Conference on Tropical Medicine and Global Health 2024" starts in Düsseldorf!
We would like to draw your attention once again to the exciting and varied programme with numerous national and international speakers (see www.dtg-conferences.de)!
The hosting societies German Society for Tropical Medicine, Travel Medicine and Global Health e.V. (DTG) and Swiss Society of Tropical and Travel Medicine (SSTTM) are delighted to welcome you to the conference!
Please note:
- For registration, see LINK
- Conference language is English, except for session on Saturday afternoon (in German)
- Annual assembly will take place for DTG and SSTTM
The State Department of Health confirmed a case rabies in a 56-year-old man who was bitten by a marmoset in the rural area of Piripiri, 166 km north of Teresina. The agency reported that the last cases of human rabies in the state occurred more than 10 years ago, in 2013, in the cities of Parnaíba and Pio IX.
In Brazil, rabies transmitted by the common marmoset primate is emerging and causing unpredictable human deaths. This primate, once endemic to the northeast of the country, has now invaded regions in the south through human-mediated introductions. However, the dynamics of rabies in this primate and the extent of spillover risk to humans remain unknown. Researchers found that outbreaks of rabies in marmosets reported to the Ministry of Health are continuously reported in new areas, including three new states since 2012, for details see publication.
Marmoset:
Prevention: Avoid contact with animals and do not feed them! Pre-exposure vaccination is particularly recommended for travelers with increased individual risk (working with animals, travel on two-wheelers, to remote areas, young children, cave explorers, possible contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: immediately wash the wound with water and soap for 15 minutes, then disinfect and in any case visit a medical center for post-exposure vaccination as soon as possible! For more information: see Flyer rabies.
Between early June and 15 August 2024, the Ministry of Health and Family Welfare of the Government of India reported 245 cases of acute encephalitis syndrome (AES) including 82 deaths (CFR 33%). Of these, 64 are confirmed cases of Chandipura virus (CHPV) infection. CHPV is endemic in India, with previous outbreaks occurring regularly, especially during the monsoon season. However, the current outbreak is the largest in the past 20 years.
The Chandipura virus (Vesiculovirus chandipura, CHPV) is a zoonotic arbovirus in the family Rhabdoviridae. The virus is endemic in several regions of India and has been detected in other countries in the South Asian subcontinent. Sporadic cases and limited outbreaks have been reported in India since 1965. The virus has also been detected in animals in some African countries (e.g. Nigeria, Senegal, Tanzania) without reported human cases.
The principal vector of CHPV in India is the sand fly Phlebotomus papatasi, which is also present in several regions of Europe. Other sand fly, mosquito and tick species are also potential vectors of the virus. A broad range of animals are suspected as vertebrate hosts of CHPV; however, little information is available on the natural ecological cycle of the virus.
The incubation period is typically short, ranging from 3 to 6 days.
CHPV infection may manifest in rapid course as a general febrile disease with meningitis and/or encephalitis (Acute Encephalitis Syndrome). Predominantly children below the age of 15 years are affected. The case fatality rate can reach 55–75%. Serological data indicate asymptomatic human infections.
There is no specific treatment or vaccine available.
WHO assessed the risk as moderate at the national level. The risk assessment will be reviewed as the situation of the outbreak evolves.
Prevention: Optimal insect bite protection 7/24 is of great importance. In case of symptoms: see medical advice immediately.
Sexually transmissible infections (STIs) represent some of the most prevalent infections globally, with an estimated 375 million new infections with one of the curable STIs each year. About 300’000 new diagnoses of bacterial STIs are reported annually by the European Union (EU)/European Economic Area (EEA) Member States to The European Surveillance System, the main source of epidemiological data for the region.
On World Sexual Health Day (4 September 2024), the European Centre for Disease Prevention and Control (ECDC) published a comprehensive review that underscores the urgent need to improve monitoring data and enhance targeted prevention interventions across Europe, see LINK
In 2024, as of 06 October 2024, 16 countries have reported 7’524 confirmed cases (+770 new confirmed cases within 1 week), including 32 deaths. The three countries with the majority of the cases in 2024 (all clades) are Democratic Republic of the Congo (6’169), Burundi, (n = 987), and Nigeria, (n = 84).
(Note: A significant number of suspected mpox cases that are clinically compatible with mpox remain untested due to limited diagnostic capacity in some African countries and therefore never got confirmed.)
In 2024, 15 countries have reported both 31’527 suspected and laboratory tested cases (+5’160 within 1 week, all clades), including 998 suspected and confirmed deaths (+2 within 1 week).
According to WHO, in 2024 as of 29 Sept 2024 the cumulative confirmed mpox cases (+ cases since last update 29 Sep 2024) were reported in the below mentioned countries (for updates, details, suspected cases, epidemic curves, see WHO LINK):
Clade Ia and b:
- D.R. Congo: according to WHO: 5’610 (+559 cases since 29 Sept 2024; note OV: in the week before the reported number was not conclusive)
Clade Ib
- Burundi: 987 confirmed cases (+134 cases since 29 Sept 2024, stable increase of confirmed cases) (plus hundreds of suspected cases)
- Uganda: 69 cases (+47 cases since 29 Sept 2024)
- Kenya: 12 cases (+4 since 29 Sept 2024)
- Rwanda: 6 cases (+0 cases since 29 Sept 2024)
- Outside Africa: Sweden (1 case, imported from Burundi), Thailand (1 case, imported from DRC), India (1 imported case)
Clade Ia:
- Republic of the Congo: 21 confirmed cases (+0)
- Central African Republic: 57 confirmed cases (+2)
- Cameroon: 6 cases (+0), including unknown number of cases with clade IIa and IIb
Clade II (a and/or b):
- Côte d’Ivoire: 67 cases (+15)
- Cameroon: 6 cases including unknown number of cases with clade 1a
- Ghana: 1 case
- Guinea: 1 case (+0)
- Morocco: 3 case (+1)
- Nigeria: 84 cases (+6)
- South Africa: 25 cases (+0)
In addition, mpox cases have been reported in Africa in 2024 without specification of the clade:
- Gabon: 2 cases (+0)
- Liberia: 14 cases (+1)
Epicurve for Ib clade cases as 6 October 2024:
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet Mpox).
General precautions
- Worldwide:
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- Wash your hands often with soap + water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- Avoid touching potentially contaminated personal items such as bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
- Avoid sex with sick persons; use of condoms for up to 12 weeks if you sexual partner have had mpox.
- Follow advice of local authorities.
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- When travelling to endemic / epidemic areas in Africa, in addition to above mentioned general precautions:
- Avoid contact with and animals in areas where mpox regularly occurs.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, as of 3 October 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi in case of:
- Clinical, research or laboratory work
- Working with animals
(a broader indication is still under discussion)
2. People staying outside of Province Equateur and / or Eastern D.R. Congo (South/North Kivu) and / or Burundi (worldwide) in case of:
- Increased risk (e.g. laboratory workers handling mpox virus, men who have sex with men, trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox.
- People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
Wash your hands often with soap /water or an alcohol-based hand sanitizer containing at least 60% alcohol. - You should not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries in the previous 21 days.
- Further information on evaluation and diagnosis: see CDC LINK.
In 2024, as of 01 September 2024, 15 countries have reported 3’891 confirmed cases, including 32 deaths. The three countries with the majority of the cases in 2024 are The Democratic Republic of the Congo, (n = 3’361), Burundi, (n = 328), and Nigeria (n = 48).
Note: a significant number of suspected cases, that are clinically compatible with mpox are not tested due to limited diagnostic capacity and never get confirmed. WHO efforts on integrating these data is currently ongoing and will be included in future updates. Not all countries have robust surveillance systems for mpox, so case counts are likely to be underestimates.
According to WHO, in 2024 as of 1 Sept 2024, mpox due to monkeypox virus clade I were reported in (for updates, details, epidemic curves, see WHO LINK):
Clade Ia and b:
- D.R. Congo: According to WHO: 3’361 cases. Increasing trend in number of cases.
According to Africa CDC, update 31 Aug 2024: Since the last update (23 August 2024 ), the MoH reported 1’838 confirmed, 1’095 suspected and 35 deaths (CFR: 2.2%) of mpox from 16 provinces. This is a 137% increase in the number of new cases reported compared to the last update. Cumulatively, 4’799 confirmed, 17’801 suspected and 610 deaths (CFR: 3.4%) of mpox have been reported from all 26 provinces in DRC. Children <15 years accounted for 66% of cases and 82% of deaths. Of the confirmed cases, 73% were males. Clade Ia and Ib was isolated from the confirmed cases.
Clade Ib
- Burundi: 328 confirmed cases (plus more than 700 cases suspected cases), including more than 190 hospitalized patients. Increasing trend in cases (+8 % within one week).
The majority of case are from North Bujumbura, Kayanza and South Bujumbura district. A total of 29 districts out of 49 districts) have reported at least one positive mpox case. - Rwanda: 4 cases
- Uganda: 10 cases
- Kenya: 4 cases
- Outside Africa: Sweden (1 case, imported from Burundi), Thailand (1 case, imported from DRC)
Clade Ia:
- D.R. Congo: 23 cases
- Republic of the Congo: 49 confirmed cases
- Central African Republic: 45 confirmed cases
- Cameroon: 5 cases including unknown number of cases with clade IIa and IIb
Mpox due to monkeypox virus clade II (a and b) reported in 2024 (for updates, details, epidemic curves, see WHO LINK):
- Côte d’Ivoire: 28 cases
- Nigeria: 48 cases
- South Africa: 24 cases
- Marocco: 1 case
- Cameroon: 5 cases including unknown number of cases with clade 1a
In addition, mpox cases have been reported in Africa without specification of the clade in 2024:
- Gabon: 2 cases
- Guinea: 1 case
- Liberia: 7 cases
Clades globally detected (1 Jan 2022 to 01 Sept 2024), Link Outbreak status (active transmission = red), Link
WHO conducted the latest global mpox risk assessment in August 2024. Based on the available information, the risk was assessed as:
- In eastern Democratic Republic of the Congo and neighbouring countries, the overall risk is assessed as high.
- In areas of the Democratic Republic of the Congo where mpox is endemic, mpox risk is assessed as high.
- In Nigeria and other countries of West, Central and East Africa where mpox is endemic, mpox risk is assessed as moderate.
WHO risk assesment, see LINK.
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic (see also Factsheet mpox).
General precautions
- Worldwide:
- Avoid close, skin-to-skin contact with people who have or may have mpox or people who have a rash (e.g., pimples, blisters, scabs).
- Wash your hands often with soap + water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- Avoid touching potentially contaminated personal items such as bedding/clothing, towels or sharing eating utensils/cups, food or drink with a person who has, or may have mpox.
- Avoid sex with sick persons; use of condoms for up to 12 weeks if you sexual partner have had mpox.
- Follow advice of local authorities.
- When travelling to endemic / epidemic areas in Africa, in addition to above mentioned general precautions:
- Avoid contact with and animals in areas where mpox regularly occurs.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid contact with and animals in areas where mpox regularly occurs.
Vaccination
A vaccination against mpox is available (Jynneos®, manufactured by Bavarian Nordic). The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, status 30 August 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Eastern D.R. Congo and Burundi in case of:
- Clinical, research or laboratory work
- Working with animals
(of note: broader indication is under discussion)
2. People staying outside of Eastern D.R. Congo and Burundi (worldwide) in case of
- Increase risk (e.g. laboratory workers handling mpox virus, men who have sex with men or trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine against mpox (e.g. Jynneos®) is also effective against the new clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
- Wash your hands often with soap /water or an alcohol-based hand sanitizer containing at least 60% alcohol.
- You should not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries in the previous 21 days.
- Further information on evaluation and diagnosis: see CDC LINK.
Swiss recommendations: all persons born after 1963 who have no documented protection against the infection (antibodies or 2 documented vaccinations) should be vaccinated twice with MMR vaccine.
In the event of an epidemic in the region or contact with a measles case, vaccination is recommended from the age of 6 months.
At least 6 people have died and more have been hospitalized in intensive care unit due to methanol intoxication after consumption of punched alcohol.
According to the police in Bangkok, samples of homemade liquor from the 18 stalls contained hazardous levels of methanol.
Two suspected Nipah cases have been reported from the state of Kerala. The case are hospitalized and isolated. Investigations are ongoing.
The Nipah virus (NiV) is a viral disease that can cause a severe clinical picture. It was first detected in 1999 during an outbreak in Malaysia and Singapore. Since then, several outbreaks have been reported in South and Southeast Asia.
NiV is most commonly transmitted via fruit bats through direct or indirect contact with their faeces. Tree fruit or sap made from it that is contaminated with bat faeces is often considered a source of infection. Human-to-human transmission has been reported when caring for infected patients. In addition, pigs can also be infected. The disease spectrum ranges from (mostly) asymptomatic courses to flu-like symptoms with high fever, headache and muscle pain to encephalitis with severe neurological or other complications. Mortality is high (40-70%).
The oropouche virus outbreak in Cuba is still ongoing and the detection of cases in returning travelers continuous.
The U.S. Centers for Disease Control and Prevention (CDC) reported on 27 Aug 2024 the detection of 21 cases of oropouche fever in people who returned from Cuba, 3 of whom required hospitalization. These cases were recorded up to 16 Aug 2024, and most of those affected presented symptoms between May and July 2024.
Canary islands: In August three cases of oropouche virus infection have been confirmed on Canary islands among travelers returning from Cuba.
According to WHO, as of 20 July 2024, a total of 8’078 confirmed oropouche cases, including two deaths, have been reported in the Region of the Americas, across five countries: Bolivia, Brazil, Colombia, Cuba, and Peru.
Oropouche fever is a viral disease that is transmitted by mosquito bites. The virus is found in several regions of the Americas, particularly in Brazil, Colombia, Cuba, Ecuador, French Guiana, Panama, Peru and Trinidad and Tobago.
The clinical picture includes dengue-like symptoms with sudden onset of high fever, headache, myalgia, skin rash, joint pain and vomiting. The disease usually lasts 3-6 days. A short-term recurrence of symptoms can occur in up to 60% of cases. Rare complications include inflammation of the brain. In 2024, a small number of cases of transmission from mother to unborn child (vertical transmission) were reported for the first time.
Prevention: Optimal mosquito protection 24/7 (also against other mosquito-borne diseases such as dengue, Zika, Chikungunyaand malaria).
Given its clinical presentation, Oropouche fever should be included in the clinical differential diagnosis for other common vector-borne diseases in the region of the Americas (e.g., malaria, dengue, chikungunya, Zika, yellow fever.
The occurrence of vertical transmission of OROV adds a new dimension to the pathogenicity of the virus. The extent of possible foetal malformations or death in the context of an OROV outbreak situation is currently still unclear and is being investigated. Until further data is available, pregnant women and women planning to be pregnant should be provided with comprehensive information during pre-travel consultation on the OROV outbreak and the potential of miscarriage, fetal malformation or death. The current outbreaks occur in regions where Zika virus is also endemic, and travel advice for pregnant women related to ZIKV can also adequately address the potential risk associated with Oropouche virus disease; for detailed ECTM recommendations on Zika prevention, see LINK.
- Following the report of an imported Monkeypox virus (MPXV) clade Ib case in Sweden on 15 August 2024 in a returning traveler from Burundi, Thailand reported a confirmed imported case due to MPXV clade Ib on 22 August 2024. The case is a European man, with travel history to the Democratic Republic of Congo.
- On August 22, 2024, Gabon reported a suspected case of mpox clade Ib in a person with a travel history to Uganda (LINK).
Epidemiological situation: Mpox outbreaks are caused by different clades, clades 1 and 2, see EpiNews as of 16 August 2024. Historically, clade 1 has been associated with a higher percentage of people with mpox developing severe illness or dying, compared to clade 2 (responsible for the global spread in 2022). D.R. Congo (DRC) has been the most affected country, with a large increase of mpox cases due to MPXV clade I being reported since November 2023. In April 2024, sequencing of mpox cases from Kamituga in South Kivu province in eastern DRC, within the context of an observational study, identified a subtype of clade I, clade Ib. Both MPXV clade Ia and clade Ib have been circulating in DRC, while clade Ia has been detected in Congo and Central African Republic.
Geographical spread of the new MPXV clade Ib variant occurs via transport routes through sexual contact (e.g. sex workers), and then local transmission is observed in households and other settings (which are becoming increasingly important).
In recent weeks, confirmed mpox cases due to MPXV clade Ib have been reported by countries neighbouring DRC, such as:
- Burundi (highest number of cases outside DRC): As of 17 August 2024, there had been 545 alerts of mpox cases since the outbreak declaration, of which 474 suspected cases (86.9%) had been investigated and validated. Of 358 suspected cases tested, 142 (39.7%) tested positive for MPXV. Genomic sequencing analysis has confirmed clade Ib MPXV. About 37.5 cases % are among children <10 years old.
- Kenya. 1 case confirmed, for details see LINK. As of 13 August, a total of 14 suspected cases had been identified, one case had tested positive for MPXV Clade Ib, 12 suspected cases had tested negative, and the test result for one case was pending.
- Rwanda: 2 confirmed cases in July and 2 confirmed cases in August.
- Uganda: 2 confirmed cases
On 14 August 2024, WHO declared the current clade I monkeypox virus outbreak a public health emergency of international concern (PHEIC).
The type of exposure reported by cases in DRC includes sexual contact, non-sexual direct contact, household contact and healthcare facility contacts. The cases reported in Rwanda had travel history to DRC and Burundi, investigation showed that the cases reported by Uganda took place outside the country, while the case reported in Kenya was detected at a point of entry. For clade Ib (reported in Eastern DRC, Burundi, Rwanda, Uganda and Kenya), close physical contact (sexual contact) has been documented as the predominant mode of transmission, while for clade Ia (in endemic areas of DRC, Congo and CAR) multiple modes of transmission have been documented including zoonotic transmission.
For details of the cases, epidemiology, public health response and WHO advice, see WHO LINK.
Follow local media and local health authority advice. The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic:
General precautions:
- Refrain from sexual or other close contact with people who are sick with signs and symptoms of mpox, including those with skin lesions or genital lesions.
- Avoid contact with wild animals (alive or dead) in areas where mpox regularly occurs.
- Avoid contact with contaminated materials used by people who are sick (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with wild animals.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid sex with sick persons and use of condoms for up to 12 weeks after the convalescence of the sexual partner.
A vaccination against mpox is available (Jynneos®, manufacture Bavarian Nordic). There is an increased demand worldwide with risk of vaccine shortage. The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, status 30 August 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
People staying or travelling to Eastern D.R. Congo and Burundi in case of:
- Clinical or research or laboratory work
- Working with animals
- (of note: broader indication is under discussion)
People staying outside of Eastern D.R. Congo and Burundi (worldwide) in case of
- Increase risk (e.g. laboratory workers handling mpox virus, men who have sex with men or trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine (Jynneos®) is also effective against the new clade I. This vaccine is considered safe and highly effective in preventing severe mpox disease.
In case of symptoms:
- Seek medical attention immediately
If you are diagnosed with mpox:
- Please stay at home (isolate yourself) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should regularly clean and disinfect the spaces they use to limit household contamination.
- Wash your hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
- Youshould not have sex while symptomatic and while you have lesions or symptoms. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- For more information: see Factsheet Mpox.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries (ROC, CAR, Rwanda, Burundi, Uganda, Zambia, Angola, Tanzania, and South Sudan) in the previous 21 days.
- Further information on Evaluation and Diagnosis: see CDC LINK.
According to the media, the Nigerian government has mandated that incoming passengers to the country (through the airports), fill out a health declaration form to ensure safety against infectious diseases.
The reintroduction of the protocols by the Nigerian government through the Port Health Services under the Federal Ministry of Health and Social Welfare is connected to the recent outbreak of mpox (former ‘monkeypox’) in the Democratic Republic of Congo (DRC) and other African countries.
WHO Director-General Dr Tedros has determined that the upsurge of mpox (formerly monkeypox) in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR). The PHEIC will help to take further coordinated international action to support countries in combating disease outbreaks.
This PHEIC determination is the second in two years relating to mpox. Mpox was first detected in humans in 1970, in the DRC. The viral disease is caused by the Monkeypox virus (MPXV), which is present in the wildlife (in certain small mammals) and the disease is considered endemic in countries in central and west Africa. In July 2022, the multi-country outbreak of mpox was declared a PHEIC after an outbreak occurred in Europe and spread rapidly via sexual contact across a range of countries where the virus had not been seen before. That PHEIC was declared over in May 2023 after there had been a sustained decline in global cases.
Since November 2023, the Democratic Republic of the Congo (DRC) has seen a significant increase in mpox cases and the emergence of a new mpox clade I. The country has reported over 16’000 new cases and more than 500 deaths in 2024. Mpox outbreaks are caused by different clades, clades 1 and 2. Historically, clade 1 has been associated with a higher percentage of people with mpox developing severe illness or dying, compared to clade 2. The clades are now subdivided into clade 1a, 1b and clade 2a, 2b.
- Clade 1a is the clade endemic in DRC and other central and East African countries (e.g. the Central African Republic and the Republic of Congo) for decades, it affects mostly children and is spreading through multiple mode of transmission (including animal-to human transmission, close nonsexual contact, sexual contact).
- Clade 1b, identified since September 2023, is currently causing the outbreak in eastern DRC and neighboring countries (Burundi, Rwanda, Kenya, and Uganda; and more recently in a returning traveler from Burundi to Sweden), it affects mostly adults of both sex and is spreading predominantly through intimal contact (sexual networks). Nonsexual transmission is also happening to a lesser extent. At present, there is no evidence that it is more transmissible or more severe than the clade 1a.
- Clade 2a is endemic in various countries of West Africa for decades with low incidence and is spreading through multiple modes of transmission like clade 1a.
- Clade 2b is the clade at the origin of the 2022/2023 global outbreak (116 countries), it affects mostly men (>96%) and is spreading primarily through sexual contact (particularly men having sex with men). It is still ongoing and could affect people with risk factors in all countries around the world, including African countries.
Details to Mpox, see LINKs of Swiss FOPH, Robert Koch-Institute Germany, ECDC, CDC.
Countries where mpox virus clade I and/or clade II have been detected:
Follow local media and local health authority advice.
The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic:
General precautions:
- Refrain from sexual or other close contact with people who are sick with signs and symptoms of mpox, including those with skin lesions or genital lesions.
- Avoid contact with wild animals (alive or dead) in areas where mpox regularly occurs.
- Avoiding contact with contaminated materials used by people who are sick (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with wild animals.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid sex with sick persons and use of condoms for up to 12 weeks after the convalescence of the sexual partner.
A vaccination against mpox is available (Jynneos®, manufacture Bavarian Nordic). There is an increased demand worldwide with risk of vaccine shortage. The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, status 16 August 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Eastern D.R. Congo and Burundi in case of:
- Clinical or research or laboratory work
- Working with animals
2. People staying outside of Eastern D.R. Congo and Burundi (worldwide) in case of:
- Increase risk (e.g. laboratory workers handling mpox virus, men who have sex with men or trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine (Jynneos®) is also effective against the new clade I. This vaccine is considered safe and highly effective in preventing severe Mpox disease.
In case of symptoms:
- Please stay at home (isolate) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should clean and disinfect the spaces they occupy regularly to limit household contamination.
- Wash hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
- You should not have sex while symptomatic and while lesions are present. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- Further information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries (ROC, CAR, Rwanda, Burundi, Uganda, Zambia, Angola, Tanzania, and South Sudan) in the previous 21 days.
- Further information on Evaluation and Diagnosis: see CDC LINK.
The European Center for Disease Control (ECDC) has issued a risk assessment on 16 August 2024 with specific advice, for details see LINK.
Following the massive flooding at the end of July, the number of leptospirosis cases is rising at an alarming rates.
The Philippine Department of Health on Saturday ordered all hospitals in the capital to ‘activate’ their leptospirosis capacity plan.
On 8 August 2024, three additional autochthonous cases of dengue have been reported in the Pyrénées, Orientales, Lozère and Gard departments.
On 2 August 2024, an autochthonous case of dengue in a person living in La Colle-sur-Loup, Alpes-Maritimes department, Provence-Alpes-Côte d'Azur region. This is the first locally acquired dengue case in the region in 2024. Recently, a second case was reported from the same region.
Overall, France has reported six locally acquired dengue cases in 2024.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
- The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
At the end of July 2024, Swissmedic authorised the Qdenga vaccine from manufacturer Takeda Pharma AG. The vaccine is licensed for people aged four and over.
The Swiss Expert Committee for Travel Medicine (ECTM) assessed the published and unpublished data for the Qdenga® vaccine. In line with the recommendation of WHO and other European countries, the Swiss ECTM issues the following recommendation:
- Vaccination with Qdenga® can be recommended for travellers from 6 years old and older who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission.
- Vaccination against dengue fever virus with Qdenga® in persons with no evidence of previous dengue fever infection is not recommended.
Previous dengue infection is defined as i) a laboratory confirmed dengue infection (PCR, antigen or seroconversion) or ii) a compatible history of dengue infection with a positive IgG serological test.
This is a precautionary decision, since the current data also include the possibility that people who are vaccinated with Qdenga® before a first dengue infection may experience a more severe course of the disease when infected after vaccination. A consultation with a specialist in tropical and travel medicine is recommended.
Travel medicine advisors should provide concise communication in accessible language on the complexity and risk/benefit evaluation for the use of dengue vaccines in travellers.
The full ECTM statement including background information is available at LINK.
Information on Dengue, including Factsheets: Vaccinations – HealthyTravel.
Swissmedic, 2.8.2024 | WHO 3.5.2024 position paper on dengue vaccine
Vaccination against Dengue fever for Travellers – Statement of the Swiss Expert Committee for Travel Medicine, an organ of the Swiss Society for Tropical and Travel Medicine, August 2024, LINK.
Information about rabies and what to do if exposed is important for all travelers.
Prevention: Avoid contact with animals! Do not feed animals either! Pre-exposure vaccination is particularly recommended for travelers with increased individual risk (working with animals, travel on two-wheelers, to remote areas, young children, cave explorers, possible contact with bats, etc.).
Behavior after exposure: After an animal bite/scratch: immediately wash the wound with water and soap for 15 minutes, then disinfect and in any case visit a medical center for post-exposure vaccination as soon as possible! For more information: see factsheet Rabies.
In June and July 2024, 19 imported cases of Oropouche virus (OROV) disease were reported for the first time in EU countries: Spain (12), Italy (5), and Germany (2), eighteen of the cases had a travel history to Cuba and one to Brazil.
The principal vector of OROV (Culicoides paraensis midge) is widely distributed across the Americas, but absent in Europe. To date, there has been a lack of evidence as to whether European midges or mosquitoes could transmit the virus. To date, no secondary transmission has ever been reported. Therefore, the risk of locally acquired OROV disease in the EU/EEA is low.
According to ECDC, the likelihood of infection for travellers to, or residing in epidemic areas in South and Central America is currently assessed as moderate. Further imported cases to Europe are likely.
Prevention: Optimal mosquito protection 24/7 (also against other mosquito-borne diseases such as dengue, Zika, Chikungunya and malaria).
Given its clinical presentation, Oropouche fever should be included in the clinical differential diagnosis for other common vector-borne diseases in the region of the Americas (e.g., malaria, dengue, chikungunya, Zika, yellow fever.
The occurrence of vertical transmission of OROV adds a new dimension to the pathogenicity of the virus. The extent of possible foetal malformations or death in the context of an OROV outbreak situation is currently still unclear and is being investigated. Until further data is available, Pregnant women and women planning to be pregnant should be provided with comprehensive information during pre-travel consultation on the OROV outbreak and the potential of miscarriage, fetal malformation or death. The current outbreaks occur in regions where Zika virus is also endemic, and travel advice for pregnant women related to ZIKV can also adequately address the potential risk associated with Oropouche virus disease; for detailed ECTM recommendations on Zika prevention, see LINK.
Due to heavy rainfalls and flooding, the risk for leptospirosis may be increased.
Wear waterproof protective clothing/boots when wading through water! Cuts or scratches should be covered with waterproof bandages. Vaccination for travelers is not available.
On 31 July 2024, France reported a confirmed, autochthonous case of chikungunya virus (CHIKV) disease in Île-de-France with suspected exposure in Paris (Paris Department) and Gennevilliers (Hauts-de-Seine Department). The case had the onset of symptoms on 18 July 2024. Since 1 May and as of 30 July 2024, nine imported chikungunya cases have been reported in France.
On 2 August 2024, the Alpes-Maritimes department reported its first locally acquired case of dengue in France for the 2024 season.
Oropouche fever is transmitted by insects and mosquitoes and was first detected in the blood of a sloth in Brazil in 1960. Since then, cases have been reported repeatedly, particularly in the Amazon region and other Latin American countries. According to the Brazilian government, at least 7,236 cases have been reported nationwide.
The disease has symptoms similar to those of dengue fever, albeit milder. Brazilian health authorities are also investigating six possible cases of vertical transmission of the disease, i.e. between a pregnant mother and her child.
These first deaths reported by Brazil coincide with a dengue outbreak that has been raging in the country this year and is the worst in the country's history, with at least 4,824 confirmed deaths since January 1, 2024.
The health authorities are warning against the consumption of buffer fish products that have reached the markets. The buffer fish has migrated from the Indian Ocean via the Red Sea and the Suez Canal into the waters of the Mediterranean and is an invasive species. It can grow to more than one metre in length. It has been found in coastal waters from Turkey, Syria, Cyprus and Egypt to Gibraltar. The takifugu (fugu) or pufferfish can contain the toxin tetrodotoxin, which it absorbs and accumulates in the food chain via toxic microorganisms. The toxin is heat-resistant and odourless.
Tetrodotoxin is an extremely strong toxin that is mainly found in the liver and gonads of some fish such as pufferfish, hogfish and toadfish as well as in some amphibian, octopus and shellfish species. Poisoning in humans occurs when the muscle meat of fish is improperly prepared and consumed. Tetrodotoxin interferes with the transmission of signals from the nerves to the muscles and causes progressive muscle paralysis. The symptoms can lead to paralysis, unconsciousness, respiratory arrest and death within a few hours of consumption. There is no antidote.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
- The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
General precautions:
- Mass events can favor gastrointestinal and respiratory infections, therefore: careful personal and food hygiene.
- The risk of accidents can also be increased (beware of binge drinking!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhea, chlamydia, mpox, etc.): Safer sexual practices (condoms).
- COVID-19: Control, entry and return regulations, see IATA LINK.
Recommended vaccinations and other health risks:
- See country page France.
- Important! Due to several measles outbreaks in Europe: All visitors should be immune to measles!
- Vaccination against meningococcal disease may be considered.
Diseases transmitted by mosquitoes and ticks:
- Dengue fever: In 2023, locally acquired dengue cases were reported for the first time in the greater Paris area (Ile de France). Local dengue cases have been recorded in the southern departments of France for a few years now.
- West Nile virus, leishmaniasis (Mediterranean region) and tick-borne encephalitis are endemic in some parts of the country.
- It is strongly recommended to protect yourself against mosquito and tick bites around the clock throughout the country, including the cities.
Prevention: Optimal mosquito bite protection 24/7, also in cities (during the day against dengue).
In case of fever, apply paracetamol products and hydration. If you have a fever, avoid taking medications containing acetylsalicylic acid (e.g., Aspirin®), as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medications containing acetylsalicylic acid if it is already part of your regular treatment for an underlying condition.
Note on vaccination against dengue fever with Qdenga®:
- The Swiss Expert Committee for Travel Medicine (ECTM) recommends a vaccination with Qdenga® only for travelers from 6 years old who have evidence of previous dengue infection and who will be exposed in a region with significant dengue transmission. For details, see ECTM Statement.
Performing the rituals of Hajj and Umrah is strenuous and often involves long walks in hot weather. Pilgrims must ensure that they are as physically fit as possible.
Ideally, pilgrims should see their doctor at least four to six weeks before the Hajj for advice on vaccinations, food and water precautions, risks from insect bites, heat exhaustion and how to avoid injury.
Pilgrims with pre-existing medical conditions should discuss with their doctor whether traveling is an option. If they are taking medication, they should ensure that they have a sufficient supply for the time abroad and that they have a copy of their prescription with them.
The following vaccinations are recommended or mandatory (see the website of the Ministry of Health of the Kingdom of Saudi Arabia for details).
- All pilgrims should have up-to-date routine vaccinations (diphtheria/tetanus/pertussis/poliomyelitis/measles, mumps, rubella, chickenpox, etc.).
- The meningococcal vaccination (quadrivalent conjugate vaccine, Menveo®) is mandatory for all persons aged 1 year and over and must be administered at least 10 days before departure.
- Poliomyelitis vaccination: In addition to the basic immunization, a polio booster vaccination is mandatory if you are traveling from countries where wild polioviruses or circulating polioviruses have been reported.
- Hepatitis A vaccination
- Hepatitis B vaccination (especially for men due to the frequent shaving of the head on site)
- A yellow fever vaccination is mandatory when entering Saudi Arabia from countries or areas at risk of yellow fever.
- COVID-19 vaccination is recommended by the ministry of Health of the Kingdom of Saudi Arabia for people ≥12 years of age.
- Influenza vaccination, especially for risk groups.
- For other vaccinations depending on risk: see country page at www.healthytravel.ch
Recommended precautions:
- Disposable razor blades recommended for the obligatory head shave
- Good personal hygiene (hand washing, disinfection, etc.), handkerchiefs when coughing or sneezing and disposal of used handkerchiefs in a waste bin.
- Wear a face mask in large crowds.
- Avoid contact with people who appear ill and do not share their personal belongings.
- Avoid visiting and coming into contact with camels on farms, markets or in stables, and avoid drinking unpasteurized milk or eating raw meat or animal products that have not been thoroughly cooked.
- Good food and drinking water hygiene to prevent food and waterborne diseases
- Drink plenty of fluids!
- Avoid direct sunlight
- Mosquito repellent, especially during the day (dengue!)
According to the WHO, 18 countries shared their epidemiological data on meningitis between March 4 and 10, 2024.
Epidemics:
- Niger: Niamey region
- Nigeria: Bauchi state
- D.R. Congo: North Kivu province
Warnings:
- Benin: Collines region and Dinga region
- Central African Republic: Region 3 and Region 6
- Chad: Mandoul region
- D.R. Congo: Haut-Uelé Province and Bas-Uelé Province and North Ubangui Province
- Ghana: Upper West Region and Ahafo Region and North East Region
- Guinea: Conakry region (Ratoma district)
- Nigeria: Gombe State
- South Sudan: Northern region of Bahr El Ghazal
- Togo: Kara region
Previous epidemics and warnings can be found under News at www.healthytravel.ch.
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important strains of meningitis is available as prophylaxis for adults and children over 1 year of age.
According to the WHO, 18 countries submitted their epidemiological data on meningitis between February 18 and March 3, 2024 (week 7 to 9).
Epidemics:
- Nigeria: Gombe State
- D.R. Congo: North Kivu province
Warnings:
- D.R. Congo: Province of Haut-Uele
- Ghana: Upper West Region and Savannah Region
- Guinea: Conakry region (Ratoma district)
- Niger: Niamey region
- Senegal: Dakar region (Dakar Centre district)
- Nigeria: Bauchi State, Gombe State
- Togo: Kara region (Doufelgou district)
Further information:
- Nigeria: according to media reports, an outbreak of meningitis in Yobe state has resulted in 636 cases.
Previous epidemics and warnings can be found under News on www.healthytravel.ch
Seasonal meningitis epidemics in sub-Saharan Africa occur mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important strains of meningitis is available as a prophylaxis for adults and children over 1 year of age.
The number of dengue patients in Thailand has reached 17,783 cases so far in 2024, more than twice as many as in the corresponding period in 2023.
Optimal protection against mosquito bites around the clock, even in cities (during the day against dengue, chikungunya, Zika). In case of fever: paracetamol products and hydration. Avoid taking medication containing acetylsalicylic acid (e.g. Aspirin®) if you have a fever, as this can increase the risk of bleeding during a dengue infection. However, do not stop taking medicines containing acetylsalicylic acid if they are already part of your regular treatment for an underlying condition.
Based on the available data, many European countries and the Swiss Expert Committee for Travel Medicine (EKRM) currently recommend vaccination with Qdenga® only for certain travelers and in special situations. Advice from a specialist in tropical and travel medicine is therefore recommended.
Dengue fever, endemic in many tropical and subtropical countries, is a major cause of illness in travelers, but severe dengue fever and resulting hospitalizations or deaths are rare in this population. There are two vaccines against dengue fever, Dengvaxia® and Qdenga®. While there is no recommendation for Dengvaxia® for use in travelers, Qdenga® has been approved for travelers in many European countries since December 2022. Swissmedic's approval for use in Switzerland is expected in the second half of 2024.
The Swiss Expert Committee for Travel Medicine (EKRM) has evaluated the published and unpublished data on the Qdenga® vaccine and makes the following recommendation:
- Vaccination against dengue fever virus with Qdenga® in persons without previous dengue fever infection is not recommended.
- Vaccination with Qdenga® may be recommended for travelers 4 years of age and older if they have had a confirmed previous dengue infection AND will be exposed in a region with significant dengue transmission.
Travel health advisors should provide information in plain language about the complexities and risk-benefit trade-offs of using dengue vaccines in travelers.
Details of the position statement can be found at LINK.
According to the WHO, 18 countries submitted their epidemiological data on meningitis between January 29 and February 18, 2024 (week 5 to 7).
Epidemics:
- Ethiopia: SNNP region (Jinka Town and Leku Town)
- D.R. Congo: North Kivu province and Ituri province
Warnings:
- Benin: Zou region (Abomey district), Collines region (Bante district) and Borgou region (Nikki district)
- Cameroon: Est region (Lomie district)
- D.R. Congo: Bas-Uele province and Equateur province
- Ghana: Upper West Region
- Guinea: Conakry region (Ratoma district)
- Nigeria: Bauchi State, Gombe State
- Togo: Kara region (Doufelgou district)
Previous epidemics and warnings can be found under News at www.healthytravel.ch
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important strains of meningitis is available as prophylaxis for adults and children over 1 year of age.
Between January 22 and 28, 2024 (week 4), 18 countries reported their meningitis epidemiological data.
Epidemics:
- Mali: Gao region
- Nigeria: Jigawa State
Warnings:
- Benin: Littoral region (Cotonou district)
- Ghana: Upper West Region
- Nigeria: Yobe State and Bauchi State
Previous epidemics and warnings can be found at www.healthytravel.ch.
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of the rains. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.
According to Médecins Sans Frontières (MSF), 3,965 patients were treated for measles in Borno State in Nigeria from October to December 2023. The increase in the number of cases could be due to the fact that public health actors were unable to achieve the 95% vaccination rate due to the uncertain situation in the region. In addition, the interruption of routine childhood vaccinations during the COVID-19 pandemic contributed to the increase in cases.
On February 12, 2024, the Centres for Disease Control and Prevention (CDC) published the top 10 countries with measles outbreaks (data refer to the period July - December 2023):
- Yemen 18,464
- Azerbaijan 13,721
- Kazakhstan 13,195
- India 12,301
- Ethiopia 10,060
- Russian Federation 7,720
- Iraq 7,601
- Pakistan 7,027
- Kyrgyzstan 5,777
- Indonesia 3,205
Measles outbreaks are reported when the number of reported cases in an area is higher than the expected number of cases.
In the 2nd and 3rd week of 2024, 21 countries have reported their epidemiological data on meningitis:
Epidemic:
- Ethiopia: Jinka Town (since week 1/2024)
Warning:
- Benin: Littoral Region (Cotonou District)
- Ghana: Upper West Region (Jirapa and Nandom districts) and Northern Region (Zabzugu district)
- Nigeria: Bauchi State (Damban District) and Jigawa State (Biriniwa District)- D.R. Congo: Haut-Uele and North Kivu
- Chad: Mandoul region (Goundi district)
Previous epidemics and warnings can be found at EpiNews or at www.healthytravel.ch.
Seasonal meningitis epidemics occur in sub-Saharan Africa mainly during the dry season, usually from December to June. They decline rapidly with the onset of rainfall. In general, the meningococcal serogroups A, C, W and X are responsible for these outbreaks. The disease spreads from person to person by droplets. If symptoms (high fever, severe headache and vomiting) occur, a doctor should be consulted immediately and antibiotic therapy started, as the disease can lead to life-threatening conditions within hours. Vaccination against the most important meningitis strains is available as prophylaxis for adults and children over 1 year of age.
In 2023, 171 cases of leptospirosis were recorded in Reunion Island, more than 70% of which occurred between January and June.
Leptospirosis is a bacterial disease that occurs worldwide, particularly frequently in tropical countries during the rainy or flooding season. It is transmitted through contact between small skin lesions and water contaminated with urine (mainly from infected rats, dogs, pigs, cows, etc.). The risk of infection increases when camping or during water-related activities (swimming, kayaking, wading through watercourses). The disease can be treated with antibiotics if diagnosed in time.
The following precautions are recommended:
General:
- Mass events can favour gastrointestinal and respiratory infections, therefore: careful personal and food hygiene.
- The risk of accidents can also be increased (CAVE alcohol!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhoea, chlamydia, etc.): Safer sex practices (condoms).
- COVID-19: Check, entry and return regulations, see IATA LINK.
- Observe strict personal hygiene and adhere to the recommendations and regulations of your host country
Recommended vaccinations and other health risks: See the relevant country page at www.healthytravel.ch/countries/. Vaccination against meningococcal disease may be considered.
It is strongly recommended that you protect yourself against mosquitoes around the clock throughout the country, including in cities, to prevent diseases such as
Dengue, Chikungunya and Zika. The city of Rio de Janeiro is malaria-free, but the disease is endemic in the Atlantic rainforest of the state of Rio de Janeiro. Further malaria risk areas and
recommended prevention measures can be found on the Brazil country page www.healthytravel.ch .
Since the beginning of 2023 and up to January 11, 2024, a total of 777 Zika virus infections (ZIKV) have been reported in Thailand. These have been registered in 36 provinces, with the central and northern regions being the most affected. According to the government, 758 people tested positive (including 33 pregnant women), compared to only 190 in 2022 and 63 in 2021. It is currently unclear whether the case numbers in 2023 are due to an increase in awareness and/or diagnostic capacity or an increase in ZIKV circulation.
In December 2023, three Zika cases were imported to Europe after a stay in Thailand.
Optimal measures to prevent mosquito bites around the clock, see factsheet Protection against mosquito and tick bites.
Although the US CDC map (last updated December 8, 2023) does not yet show Thailand as a country with a current Zika outbreak, an increased risk of Zika transmission in Thailand cannot be ruled out. As soon as more data is available, the Expert Committee on Travel Medicine (ECRM) will reassess the situation.
Until further information is available, the EKRM recommends that
- Travelers to Thailand should be informed about the situation, the possible risk of congenital infection by ZIKV and its sexual transmission.
- To prevent possible sexual transmission of the virus, it is recommended to use a condom/femidom during the trip and for at least 2 months after return.
- Due to the risk of fetal malformations, pregnant women should postpone planned trips to Thailand at any time during pregnancy (in case of unavoidable travel, a consultation with a specialist in travel medicine is recommended before departure).
- Women who wish to become pregnant should wait at least 2 months after their return (or that of their partner) from an area with an increased risk of Zika transmission.
For details, see the Swiss ECRM recommendation from 2019: LINK
The following precautions are recommended:
General:
- Mass events can favour gastrointestinal and respiratory infections, therefore: careful personal and food hygiene.
- The risk of accidents can also be increased (CAVE alcohol!).
- To avoid sexually transmitted diseases (HIV, syphilis, gonorrhoea, chlamydia, etc.): Safer sex practices (condoms).
- COVID-19: Check, entry and return regulations, see IATA LINK. Observe strict personal hygiene and follow the recommendations and regulations of your host country
- Avian influenza is particularly widespread in China. Avoid contact with poultry and their droppings. Do not visit bird and poultry markets/farms and do not import poultry meat from China. Travellers should also wash their hands frequently with soap and water.
Recommended vaccinations and other health risks: See the respective country page at www.healthytravel.ch/countries/.
The outbreak of Streptococcus suis infections in Thailand continues: 137 infections and 8 deaths have been reported within the last three weeks. The increase in infections is linked to the consumption of raw or undercooked pork, sausages and raw pork blood salad.
Infection with Streptococcus suis is usually asymptomatic in pigs. Humans can become infected by eating contaminated raw or undercooked pork and fresh blood or through direct contact with infected pigs or pork products. Symptoms include high fever, severe headache and dizziness, vomiting, diarrhea, neck stiffness, intolerance to light, decreased level of consciousness and hearing loss.
Health authorities are warning people to protect themselves after a case of Japanese encephalitis virus (JEV) infection was detected in New South Wales (NSW). Following the persistently wet and warm weather over the vacation period, mosquito populations in NSW are currently thriving.
In 2022, there was one outbreak of JEV in Australia with 45 cases detected mainly in the Murray Valley in New South Wales.
Optimal protection against mosquito bites, especially at dusk and at night. In addition, the Swiss Expert Commission for Travel Medicine (EKMT) recommends vaccination against JE for travelers to Australia for high-risk travelers such as:
- Work / extensive outdoor activities in rural areas
- Long-term stays (>4 weeks) or during an ongoing outbreak.
According to the Thai Ministry of Health, there has been a significant increase in Zika virus cases, with around 100 new cases are reported every month.
Around 660 cases have been registered since June 2023, mainly in the northern and central areas. Cases of Zika virus have also been detected in people who had recently returned from Thailand. Zika is endemic in Thailand and other parts of the world, but a current outbreak (epidemic) is not currently recorded in Thailand, according to the US Center of Disease Control and Prevention (CDC) (see CDC map).
Optimum protection against mosquito bites around the clock, even in cities (during the day against chikungunya, dengue, Zika and other viruses, at dusk and at night against malaria). Detailed information on Zika can be found in the Zika information sheet.
If you have a fever, take paracetamol preparations and make sure you drink enough fluids. Do not take medicines containing acetylsalicylic acid (ASA) (e.g. Aspirin®) if you have a fever, as these increase the risk of bleeding. (Note: Do not stop taking medication containing ASA if it is part of a long-term medication for an underlying illness.
In the case of fever, malaria should always be ruled out by means of a blood test.
After a three-week trip to southern Thailand (Krabi, Khao Sok, Koh Phangan, Koh Samui), two German tourists in Tübingen were diagnosed with Zikainfection.
Although the CDC does not classify Thailand as a country with a current outbreak (see CDC map), Zika is endemic in Thailand.
The WHO's annual malaria report highlights the growing threat of climate change. In 2022, there were an estimated 249 million malaria cases worldwide in 85 malaria-endemic countries and territories - significantly more than the estimated number of cases before the COVID-19 pandemic. The main countries contributing to the increase in 2022 were Pakistan, Ethiopia, Nigeria, Uganda and Papua New Guinea. The WHO African region accounted for about 94% of cases worldwide. The number of deaths amounted to an estimated 608,000. In addition to the disruption caused by COVID-19, the global malaria response is facing a growing number of threats: Drug and insecticide resistance, humanitarian crises, resource scarcity, climate change impacts and delays in program implementation, particularly in countries with a high burden of the disease.
Details can be found at WMR LINK.